| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,708 |
2,701 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,244 |
1,089 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,788 |
2,776 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,879 |
1,879 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,637 |
2,627 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,250 |
1,248 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
425 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
259 |
221 |
$6K |
| D1120 |
Prophylaxis - child |
357 |
356 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
164 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
592 |
591 |
$4K |
| D9110 |
|
236 |
233 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
203 |
$2K |